Itraconazole Toxicity and Cardiac Health Problems

Written by Graham Atherton
·
Thursday 11th April 2013

Itraconazole is an antifungal drug used widely to treat fungal infections and is active against Aspergillus, Candida and Cryptococcus. It is effective and now much cheaper as it has passed out of the period of time granted to its inventor to exclusively sell it - there are now several competing manufacturers. It seems to be an increasingly useful and used drug now it has become more accessible which is a good thing in the main but this makes it increasingly important that this drug is properly understood and its very severe potential side effects appreciated and guarded against.

The agency says that while the available evidence suggests that the risk of heart failure with short courses of itraconazole is low in healthy, young patients, prescribers should exercise caution when prescribing the drug to at-risk patients. Amendments to the product information of all itraconazole formulations have been made to reflect this information.

By April 2000 the UMC had received 43 case reports from 5 countries regarding the use of itraconazole by pregnant women. 25 of these pregnancies ended in embryonic or foetal death. The remaining 19 reports described a variety of congenital malformation or neonatal disorders. In the 38 reports in which the route of administration was specified the drug was taken orally. The data suggested that:

inspite of the approved recommendations and warnings itraconazole is being taken by pregnant women for minor indications,

reported human experience seems to lend support to the experimental evidence that itraconazole is teratogenic,

there is a predominance of abortion, and

more firm warnings may be needed in the product information.Although not apparent from the UMC reports, a further question of interest was if itraconazole might decrease the reliability of oral contraceptives and so lead to unintended exposure in pregnancy.

Care thus needs to be taken about which patients are prescribed itraconazole, adequate monitoring needs to be put in place if needed and sufficient advice given with the drug to ensure the patient is aware of the risks involved and the signs & symptoms to look out for.

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Thank you ,that was very useful.
As it can be prescribed as pulsed therapy it can be easier for the patient compared to taking other antifungals like terbinafine which must be taken daily. Hence the adverse effect should to be discussed prior to presc

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I would like to say "well done, Mark Zuckerberg" as Facebook tops 1 billion active users! But all this is while 1 billion people in the world never see a health worker in their entire lives.
The internet is the most powerful tool of our generation and there is no doubt that its influence will increase further in the future. I think we can all recognise the success of an enterprise such as Facebook and it is certainly a commendable feat to bring 1 billion people closer together on a regular basis. Well done Mark Zuckerberg!
But does this not highlight some bigger questions? When will we see the internet making a real difference?
I don't mean to belittle any enterprise such as Facebook which excites and energises a huge community, but when will we see a movement that has such an impact to save and improve billions of lives every month?
The WHO Global Health Workforce Alliance estimates that there are a billion people alive today who will never see a health worker in their lives... Ever! We are not short of the tools to change this.
So, how will this movement come about? Will it be a political push? Will it be an established company that walks in the 'right' direction? Or could it come from the grassroots?
I believe this is one of the greatest challenges of our generation, and the most exciting challenge I can think of. As a doctor and co-founder of Meducation, we have started a movement in the right direction. Meducation aims to unite the medical community - yes all of it, but we know our limits.
You can not make such an impact in one step. Most of the charitable solutions and philanthropic activity takes us huge leaps in the right direction and these are of significant importance, but will we ever see the sort of impact possible if we can't maintain the ability to push forwards with the attrition needed to effectively get this right.
I would assume that most of those who have set up an innovative and successful solution to a problem would say that they could not achieve this with an element of freedom to experiment, try different methods and approaches before finding the formula that works. Is it not the same with this problem?
The solution is going to grow from the grassroots and for us at Meducation, although we are starting with health workers in the UK, we certainly see the hopeful future where the health workers in the developing countries can gain access to the educational material and support they need from the rest of the community. With the global medical community working closely together, we will be better placed to help the 1 billion people who would have never see a health worker in their lives.
So well done Mark.... but there are still bigger fish to fry.

I’m sure there are times when all us GPs feel under-appreciated — by our patients, staff, specialist colleagues or society in general. You can’t blame them for sometimes taking us for granted — it’s part of the human condition. People don’t value what they have until they lose it, whether “it” is the ability to walk or a domestic fairy who makes sure there’s always spare toilet paper.
It’s a common lament that we can’t be at our own funerals to hear how much we’re loved. Mind you, eulogies are rarely objective and balanced. Nonetheless, it’s a pity we’re not around to hear the praise — deserved or otherwise — that is expressed once we’re gone.
The long-serving, somewhat-taken-for-granted GP has a non-fatal way of bringing out the appreciation in his or her patients and staff: moving on.
After 10 years of GP-ing in the Noosa hinterland and a lifetime of living in south-east Queensland, I headed south of the border: to northern NSW. The hardest part of the move for me — harder than selling my house in a depressed market, harder than dealing with banks, builders, real estate agents, solicitors and Australia Post, harder even than trying to get rational answers out of my telecommunications company after they cut off my internet and phone prematurely — was telling my patients that I was leaving.
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You may interpret this as my being too close to my patients or not close enough to my boyfriends, but the fact is I found the protracted process exhausting, emotionally draining and just plain horrible. The “it’s not you, it’s me” part goes without saying and
I know I am far from irreplaceable, but seeing the tears well up in countless eyes because of the words I’ve uttered was enough to break my tender heart.
Looking on the bright side, as I am wont to do, if I’d ever felt under-appreciated, I sure don’t now. I received more expressions of gratitude in those last three months than I did in the previous decade. To hear how influential I was in some of my patients’ lives put a warm glow in my battered heart. And as much as it hurt me to see my patients upset, it probably would’ve hurt me more if they’d been completely indifferent to my leaving.
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It’s nice to be appreciated!
(This blog post has been adapted from a column first published in Australian Doctor www.australiandoctor.com.au/opinions/the-last-word/the-last-word-on-moving-on- )
Dr Genevieve Yates is an Australian GP, medical educator, medico-legal presenter and writer. You can read more of her work at http://genevieveyates.com/

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Increasingly patients are taking to the Internet to find recommendations for healthcare professionals and to self-diagnose. By having an online presence your business can positively influence these conversations – engaging with the public and colleagues both locally and globally and can facilitate public access to accurate health information. The reality is social media is here to stay, so in 2014 why not make it your resolution to become part of the conversation.
To get you started and so that social media isn’t seen as such a daunting place, SocialB are providing a free eBook containing lots of fantastic advice on how to use social media within the healthcare sector ‘Twitter for Healthcare Professionals’ please visit http://www.socialmedia-trainingcourses.com/top-10-twitter-tips-ebook/ to receive your free copy.
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3. Contribute your knowledge, experience and industry information
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As a healthcare professional, you will inevitably take part in conferences, training days and possibly new research. Social media allows you to share your knowledge, enabling your market to be better informed about you and your work.
4. Treat others how you wish to be treated
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Thank you Katy Sutherland at SocialB for providing this blog post.

I'm a GP registrar in East Anglia with an interest in continuing medical education. Alex Gordon-Weeks - academic surgical registrar at Oxford - and I are undertaking a project that explores some of the difficulties that doctors face when trying to access medical courses.
Doctors complete a number of compulsory and non-compulsory educational courses during and after their medical training. Now that revalidation is compulsory doctors must provide evidence of continuing medical education. Attending courses are an ideal way of maintaining knowledge but they can be expensive and time consuming so it is important that adequate information regarding the course undertaken is provided by the course organisers. To identify areas in which these features could be improved we wish to understand more about the courses that you attend.
We have put together a short survey to obtain anonymised information that we can use to improve course provision. We would love for Meducation members to fill it in and would really appreciate your participation.
You can take the survey at http://www.surveymonkey.com/s/SSL7286. Thanks!